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Lista vs. Fielding: considerations

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Lista vs. Fielding: considerations
« on: April 15, 2013, 07:12:08 PM »
Hi all,

I have spent the last few days trying to determine which surgeon would be best for my gyno surgery, and I thought would share my findings on these two surgeons (sorry if this has already been mentioned elsewhere in the forums).

Like everyone, I want to make sure the surgeon I get will do a good job, and as far as I can tell from reading through the hundreds of stories here from people who have had surgery with either Fielding or Lista, both are very good.

The next thing on the priority list is the cost. I contacted the clinics of both of these surgeons, and the key results are:

1) Gyno surgery with Dr. Lista will not be covered by any form of medical insurance. This is because is clinic is entirely private. Financing is available, but the surgery costs ~$6000
(varying, of course, according the the details of the particular case).

2) Gyno surgery with Dr. Fielding is covered by health insurance. In particular, it does not seem to matter whether you are an Ontario resident (with OHIP) or not. I have AB health care coverage, and the surgery, I'm told, will be covered. The caveat is that liposuction is not covered, and would have to be paid out of your pocket. The reason why Fielding's surgery is covered is that it is performed at a general hospital and their surgery clinic therefore has the infrastructure to bill to health insurance. Lista has no such infrastructure.

3) General vs. local anesthetic. Dr. Lista only performs the surgery under general anesthesia, whereas I there is the option of local anesthesia with Fielding. This will of course vary depending on the case (I'm told).

4) The surgical methods of the two differ. Lista uses the PAL method, which eliminates any nipple scarring, and instead one is left with smaller scars slightly below and outward from the nipples. Fielding does the surgery via areolar incision.

[side note: I am not sure if this is true or not, but it seems to me that the PAL method may be less of a revolutionary way to perform the gyno surgery as best as possible, and more of a way to obviate the possibility of the surgery being charged to health insurance. This is because the whole procedure is considered liposuction when PAL is used, and this is usually a cosmetic procedure according to most health coverage plans. Using the method of incision and removal, the procedure can then be categorized as a reconstructive surgery, which is often covered in Canada.]

I hope this will be helpful to someone. It can be frustrating looking for a surgeon and thinking about costs and health coverage. The above factors have led me to prefer Fielding to Lista for my surgery. I think it will be a few months before I am able to get a surgery date, but when I do I will start a threat to document the experience.

Josh



Linkback: https://www.gynecomastia.org/smf/index.php?topic=27402.0

Re: Lista vs. Fielding: considerations
« Reply #1 on: April 23, 2013, 10:19:07 AM »
Thanks for the info.

Re: Lista vs. Fielding: considerations
« Reply #2 on: July 25, 2013, 02:18:45 PM »
Hi all,

I have spent the last few days trying to determine which surgeon would be best for my gyno surgery, and I thought would share my findings on these two surgeons (sorry if this has already been mentioned elsewhere in the forums).

Like everyone, I want to make sure the surgeon I get will do a good job, and as far as I can tell from reading through the hundreds of stories here from people who have had surgery with either Fielding or Lista, both are very good.

The next thing on the priority list is the cost. I contacted the clinics of both of these surgeons, and the key results are:

1) Gyno surgery with Dr. Lista will not be covered by any form of medical insurance. This is because is clinic is entirely private. Financing is available, but the surgery costs ~$6000
(varying, of course, according the the details of the particular case).

2) Gyno surgery with Dr. Fielding is covered by health insurance. In particular, it does not seem to matter whether you are an Ontario resident (with OHIP) or not. I have AB health care coverage, and the surgery, I'm told, will be covered. The caveat is that liposuction is not covered, and would have to be paid out of your pocket. The reason why Fielding's surgery is covered is that it is performed at a general hospital and their surgery clinic therefore has the infrastructure to bill to health insurance. Lista has no such infrastructure.

3) General vs. local anesthetic. Dr. Lista only performs the surgery under general anesthesia, whereas I there is the option of local anesthesia with Fielding. This will of course vary depending on the case (I'm told).

4) The surgical methods of the two differ. Lista uses the PAL method, which eliminates any nipple scarring, and instead one is left with smaller scars slightly below and outward from the nipples. Fielding does the surgery via areolar incision.

[side note: I am not sure if this is true or not, but it seems to me that the PAL method may be less of a revolutionary way to perform the gyno surgery as best as possible, and more of a way to obviate the possibility of the surgery being charged to health insurance. This is because the whole procedure is considered liposuction when PAL is used, and this is usually a cosmetic procedure according to most health coverage plans. Using the method of incision and removal, the procedure can then be categorized as a reconstructive surgery, which is often covered in Canada.]

I hope this will be helpful to someone. It can be frustrating looking for a surgeon and thinking about costs and health coverage. The above factors have led me to prefer Fielding to Lista for my surgery. I think it will be a few months before I am able to get a surgery date, but when I do I will start a threat to document the experience.

Josh



Most surgeons use the conventional lipo+excision method, exact same as Fielding, but it's not covered by OHIP for those surgeons. The reason Fielding's surgery is partially covered by insurance is because he and his staff work at the hospital.  A Plastic Surgeon working from a private clinic will not be able to bill any part of this procedure to insurance regardless of the technique (whether it's the conventional method or Lista's newer method) used in the operation.

For what it's worth, I had the surgery last week with Lista and it went great. No bruising and very minimal swelling. I would highly recommend going to him if cost is not a huge concern; if it is, then Fielding is definitely your guy because it's really a heck of a deal at his price!  But I gotta say, the technique used by Lista is great and I imagine there will be a gradual shift towards it by other doctors eventually.  I mean, why cut under around the areola if you don't have to?

Whichever doc you choose, they're well reviewed and experienced so you can't go wrong.  Best of luck!

Re: Lista vs. Fielding: considerations
« Reply #3 on: August 23, 2013, 10:36:13 PM »
Just a correction to the above. Dr. Fielding will perform a total of 4 surgical incisions for most gynecomastia cases as opposed to Dr. Lista's 2. The original post seems to suggest that the number of incisions for the two are equal which is false.

In terms of the history behind the two techniques, Dr. Lista's technique is more recent. It utilizes the liposuction technique mentioned (PAL) along with remote resection of the glandular tissue.It is a more complex technique for surgeons to perform as it requires the ability to resect glandular tissue without direct line of sight.

Using Lista's technique results in fewer surgical incisions with associated lower infection rates and smaller likelihood of permanent paresthesia around the nipples.

I would personally recommend Lista for gynecomastia surgery given the permanent effects of a less optimal surgical technique on your body, with additional scars and potential permanent numbness.

Re: Lista vs. Fielding: considerations
« Reply #4 on: August 27, 2013, 11:48:49 PM »
SO I am 19 and in London, ON and just today spoke for the first time to a doctor about my own gyne and mentioned that i understood the surgery to be covered by OHIP which he and his assistant were unusre of because they believed it had been removed from OHIP coverage, they told me they would ask colleagues about it and i am wondering if you had heard of any changes to OHIP coverage in the last few months ?

Re: Lista vs. Fielding: considerations
« Reply #5 on: August 28, 2013, 03:33:12 PM »
SO I am 19 and in London, ON and just today spoke for the first time to a doctor about my own gyne and mentioned that i understood the surgery to be covered by OHIP which he and his assistant were unusre of because they believed it had been removed from OHIP coverage, they told me they would ask colleagues about it and i am wondering if you had heard of any changes to OHIP coverage in the last few months ?

Not covered dude.  It is a cosmetic procedure.  There may have been some people who got lucky with OHIP in the past but now they just don't cover it. It may be because it's so popular now. who knows..

My advice to you is that if you can afford it (or parents don't mind paying), get it done ASAP. If you can't afford it, come up with a strategy and save the cash until you can get it done. You'll free great after it's done!


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